gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

The role of nerve conduction studies in diagnosing and staging of the carpal tunnel syndrome

Meeting Abstract

  • presenting/speaker Amina Shammat - University Emergency County Clinical Hospital Pius Brinzeu, Timisoara, Romania
  • Vladislav Gyebnar - University Emergency County Clinical Hospital Pius Brinzeu, Timisoara, Romania
  • Mihaela Mastacaneanu - CHU Martinique, SOS Main, Hopital Pierre Zobda Quitman, Fort-de-France, Martinique
  • Izabela Popa - Office of Neurology Dr Izabela Popa, Timisoara, Romania
  • Veronica Romanescu - University Emergency County Clinical Hospital Pius Brinzeu, Timisoara, Romania

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1226

doi: 10.3205/19ifssh0543, urn:nbn:de:0183-19ifssh05439

Published: February 6, 2020

© 2020 Shammat et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Carpal tunnel syndrome (CTS) diagnostic is based on clinical symptoms and physical examination, usually confirmed by electrodiagnostic methods. We wanted to assess the diagnostic value of nerve conduction studies (NCS) and if it can be correlated with intraoperative findings (retrospective study).

Methods: Between 2009-2017, 353 patients presented with symptoms of CTS. All patients underwent NCS by the same neurologist 1-3 months before surgery, resulting in CTS staging and indication for median nerve neurolysis (MNE) in selected cases. Surgery performed by the same surgeon - mini-invasive CTR +/- MNE. The operated patients have completed a questionnaire before the procedure and one year postoperatively. NCS was repeated one year after surgery.

We studied the correlation clinical symptoms / NCS result; recommendation to perform MNE based on NCS / intraoperative aspect of the median nerve; the obtained results (patient-reported outcome and postoperative NCS).

Results and Conclusions: NCS did not confirm CTS in 16 patients; other neuropathies with symptoms of median nerve entrapment were diagnosed.

We included 275 patients (446 hands). Cf. Bland (2000) electrophysiologic classification, there were 15 hands (3.36%) grade 2, 93 hands (20.85%) grade 3, 311 hands (69.73%) grade 4 and 27 hands (6.06%) grade 5. No patients with grade 1 or 6 were diagnosed during the study.

Based on NCS, the indication for MNE was recommended for 342 hands (76.68%). In all these cases, median nerve fibrosis was noted intraoperatively and MNE was done. In 8 hands we did MNE without neurologist's recommendation.

Clinical relief was noted in all cases. On visual analogue scale, the pain decreased from 6.2 preoperatively to 0.8 postoperatively, and paresthesia from 5.7 preoperatively to 0.5 postoperatively. All patients were satisfied or very satisfied with the outcome.

The electrophysiologic parameters improved: distal latencies diminished with about 0.5 ms, even to normal values, nerve conduction velocities either increased or became normal. The recovery of sensory and motor function varied from good to excellent. In situations with severe axonopathy the degree of denervation in EMG was reduced.

NCS is the standard of care for the positive and differential diagnosis of CTS and for staging the disease.

Postoperative NCS help in controversial cases (simulations, litigations, recurrences).

The recommendation for MNE based on NCS correlates excellently with intraoperative findings.

Intraoperative NCS is expected in the future.